标准颈动脉内膜切除术与采用闭合细胞支架设计和远端栓子保护的颈动脉支架置入术：年龄有影响吗？

Standard Carotid Endarterectomy versus Carotid Artery Stenting with Closed-Cell Stent Design and Distal Embolic Protection: does the age matter?

作者信息

Peluso A, Turchino D, Petrone A, Giribono A M, Bracale R, Del Guercio L, Bracale U M

机构信息

Vascular Surgery Unit, Department of Public Health, University Federico II of Naples, Naples, Italy.

Department of Medicine and Health Science, University of Molise, Campobasso, Italy.

出版信息

Transl Med UniSa. 2019 Jan 6;19:60-65. eCollection 2019 Jan-Jun.

PMID:31360669

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6581497/

Abstract

UNLABELLED

Carotid artery endarterectomy (CEA) is considered the gold standard for treatment of symptomatic and asymptomatic carotid disease. Carotid artery stenting (CAS) is a less invasive approach and therefore could be considered a viable alternative to CEA, especially in high-risk patients or those with relative contraindications to CEA (i.e. actinic stenosis, post-CEA restenosis, previous neck or tracheostomy surgery, contralateral laryngeal nerve paralysis, etc.).

METHODS

The aim of this study is to evaluate the short- and medium-term outcomes of CAS performed with a single type of closed-cell stent design and distal filter protection by comparing the procedure with CEA based upon 3 endpoints: overall survival rate, stroke free survival rate and restenosis free survival rate.The same endpoints were also evaluated in 2 different age groups, more and less than 70 years, to show possible age-based differences on outcomes.Among 105 patients (77 males, 28 females), 74 were submitted to CEA and 31 were subject to CAS.In all cases the same self-expanding stent with closed-cell design (XACT Carotid Stent, Abbott Vascular) and the same distal embolic protection device (Emboshield NAV, Abbott Vascular) were employed.

RESULTS

At 12 months, no statistically significant difference was observed in overall survival rates (CEA 93.2% vs CAS 93.5%, p=0.967) and restenosis free survival rates (CEA 94.5% vs CAS 96.8%, p=0.662).An increased stroke free survival rate was observed in the CEA group when compared to the CAS group (CEA 100.0% vs CAS 93.5%, p=0.028).The age-based endpoints didn't show any significant difference.

CONCLUSION

These results suggest that CEA still remains the gold standard of treatment for carotid stenosis given its greater efficacy in the prevention of stroke CAS. However, CAS could be considered as an alternative treatment to CEA to be used in select cases only.

摘要

未标记

颈动脉内膜切除术（CEA）被认为是治疗有症状和无症状颈动脉疾病的金标准。颈动脉支架置入术（CAS）是一种侵入性较小的方法，因此可被视为CEA的一种可行替代方案，尤其是在高危患者或有CEA相对禁忌证的患者中（即光化性狭窄、CEA术后再狭窄、既往颈部或气管造口手术、对侧喉返神经麻痹等）。

方法

本研究的目的是通过基于三个终点将该手术与CEA进行比较，评估采用单一类型的闭合细胞支架设计和远端滤器保护进行的CAS的短期和中期结果：总生存率、无卒中生存率和无再狭窄生存率。还在两个不同年龄组（70岁及以上和70岁以下）中评估了相同的终点，以显示可能存在的基于年龄的结果差异。在105例患者（77例男性，28例女性）中，74例行CEA，31例行CAS。在所有病例中，均使用相同的闭合细胞设计的自膨胀支架（XACT颈动脉支架，雅培血管）和相同的远端栓塞保护装置（Emboshield NAV，雅培血管）。

结果

在12个月时，总生存率（CEA为93.2%，CAS为93.5%，p = 0.967）和无再狭窄生存率（CEA为94.5%，CAS为96.8%，p = 0.662）未观察到统计学上的显著差异。与CAS组相比，CEA组的无卒中生存率有所提高（CEA为100.0%，CAS为93.5%，p = 0.028）。基于年龄的终点未显示任何显著差异。